Sexual dysfunction in bipolar disorder: A systematic review

Bipolar disorder (BD) involves sexual disturbances not only during affective phases but also during euthymia. Sexual dysfunctions (SD) in BD are particularly relevant, as they may negatively affect quality of life and treatment adherence. Despite their clinical impact, SD are often misdiagnosed and their characteristics remain unclear. This work aimed to review the literature on SD in patients with BD. A systematic review was conducted following PRISMA guidelines (PROSPERO ID-CRD42019130095). We included naturalistic studies of adults with BD in which sexual functioning was assessed using questionnaires/semi-structured interviews evaluating desire, arousal, orgasm, and satisfaction, or through validated diagnostic criteria. The search identified 176 eligible full-text articles, of which 37 were included, comprising 8,724 individuals with BD. The prevalence of SD varied widely (14 %-91 %) and was influenced by sample characteristics, study context, and treatment. Desire was the most frequently affected domain, and the Arizona Sexual Experiences Scale (ASEX) was the most commonly used tool. Compared to healthy controls, BD patients showed poorer sexual functioning and satisfaction. SD in BD was associated with worse quality of life, greater illness burden, and impaired psychosocial functioning. The evidence reviewed confirms that SD is a core dimension of BD, with relevant consequences for functioning and quality of life. Findings support the systematic assessment of sexual health in routine care and its integration into personalized treatment plans. Future research should clarify mechanisms and develop targeted interventions, with attention to longitudinal trajectories and the inclusion of gender and sexual minority populations.